| Shatto Street | |
|
1543 Shatto St Los Angeles CA 90017-1718 | |
| (213) 353-4407 | |
| Not Available |
| Full Name | Shatto Street |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1543 Shatto St, Los Angeles, California |
| Authorized Official Name and Position | Ronda Renee Dixon (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 3239883744 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Shatto Street 4715 Crenshaw Blvd Los Angeles CA 90043-1233 Ph: (323) 988-3744 | Shatto Street 1543 Shatto St Los Angeles CA 90017-1718 Ph: (213) 353-4407 |
| NPI Number | 1053687160 |
|---|---|
| Provider Enumeration Date | 03/23/2012 |
| Last Update Date | 03/23/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053687160 | NPI | - | NPPES |
| 197336 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 190622AN (California) | Primary |
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